Navy Wife Could Use A Break

Tamara Dietrich

Your husband ships out and you're left behind all alone to manage a household, tend the kids and get on with daily life. Sailing your little boat solo.

It can be a struggle, emotionally and physically. For 41-year-old Deanna "Dee" VanHook, who has used a wheelchair since she was 18, it's a special kind of challenge.

Not that Dee can't handle it. She has already powered through three deployments of her husband, Tom, a 39-year-old emergency room physician and lieutenant commander in the Navy.

Twice, Tom served on submarines off Hawaii. Once, he shipped off to make "foxhole calls" on combat Marines in Afghanistan.

But when Tom deploys soon to serve with a Marine shock trauma platoon in Iraq's combustible Anbar province, Dee will be left all alone for the first time to care for the couple's two children, ages 7 and 4.

It's enough to unnerve anyone, but Dee feels up to it after she and her husband took out a second mortgage on their Portsmouth home to buy a hi-tech chair called an iBOT mobility system.

You may have seen this gee-whiz device in commercials, maneuvering a seated guy up and down stairs or over curbs, elevating him to reach tall shelves and even going "off-roading" beyond paved surfaces.

"It allows me the freedom and mobility to go anywhere that I want," Dee says. "If the kids are on a playground, for instance, and you know that nice, soft, mulchy stuff that is always underneath? That would've stopped my manual chair. The iBOT, I put it into four-wheel drive, I follow my kids."

And if the kids run upstairs and won't come down even if mommy says so, now she can go up after them.

As for Tom, the iBOT gives him peace of mind about the family he's leaving behind as he heads to a war zone.

There's only one problem: The federal government won't pay for the iBOT.

The denials seem to boil down to cost and need - i.e., the iBOT costs too much (nearly $24,000) and Dee doesn't really need it.

Tom, however, insists that "TRICARE's own medical expert found that the iBOT was 'basic mobility' for Deanna, and we don't think TRICARE has the authority to disagree."

Dee can't use a manual chair anymore because, after pushing herself around for 23 years, her shoulders finally gave out. She developed double shoulder impingement syndrome - "A fancy name for saying arms weren't mean to be legs," Dee says.

I couldn't reach a TRICARE official to speak on the record; they're legally constrained from commenting on specific cases, especially those, like this one, that are on appeal and awaiting a final decision from the DoD.

A media relations officer in Northern Virginia did offer general information about coverage of iBOTs and other durable medical equipment but said he couldn't be quoted by name.

Things such as durable medical equipment are viewed on a case-by-case basis, he said, noting that they cover what's medically necessary for the individual and that determination is made by doctors, not people in what he called the "policy shop."

I asked how TRICARE might deny coverage of an iBOT once a TRICARE medical expert has already approved it.

It's always possible, the officer said, that one doctor may disagree with another in that approval process.Asked who rules on patient care if two medical experts disagree, the officer said he didn't know but would try to find out.

He said he was unaware of cost being a factor in approving or disapproving health care.

But an internal action memorandum on the VanHooks' appeal from the chief of TRICARE's Office of Medical Benefits and Reimbursement Systems, dated Dec. 19, 2006, offers some insight.

New, emerging technologies such as the iBOT may increase access and mobility, wrote Reta M. Michak.

But TRICARE, she continued, can deny coverage for "DME that has deluxe, luxury, and (or) immaterial features that increases the cost to the government compared with a similar item (i.e. standard DME) without those features, resulting in cost that is non-advantageous to the government."

Some people might consider outfitting an officer's paraplegic wife so she's physically able to care for their kids while he's sent off to serve his country "high value." Maybe even advantageous to the same government that's sending him off in the first place.

"Bear in mind," Michak continued, "that the principle behind TRICARE coverage of DME is not to enhance the personal comfort of the beneficiary, or to provide convenience for the beneficiary or the beneficiary's caretaker. The intent of the coverage is to provide the means for beneficiaries to remain cost-effectively outside an institutional setting...."